Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea (Republic of).
Z Rheumatol. 2021 May;80(4):379-392. doi: 10.1007/s00393-020-00796-1.
The relative efficacy and tolerability of tofacitinib, baricitinib, upadacitinib, and filgotinib were assessed in patients with rheumatoid arthritis (RA) with inadequate responses to biologic disease-modifying antirheumatic drugs (bDMARDs).
We performed a Bayesian network meta-analysis to combine direct and indirect evidence from randomized controlled trials (RCTs) to examine the efficacy and safety of tofacitinib, baricitinib, upadacitinib, and filgotinib in RA patients with inadequate responses to bDMARDs.
Four RCTs comprising 1399 patients met the inclusion criteria. Tofacitinib, baricitinib, upadacitinib, and filgotinib achieved significant American College of Rheumatology 20% (ACR20) responses versus placebo. The ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that upadacitinib 15 mg had the highest probability of being the best treatment for achieving the ACR20 response rate, followed by filgotinib 200 mg, baricitinib 4 mg, filgotinib 100 mg, tofacitinib 5 mg, and placebo. The ranking in SUCRA based on the ACR50 response rate indicated that baricitinib 4 mg had the highest probability of achieving the ACR50 response rate, followed by filgotinib 200 mg, tofacitinib 5 mg, upadacitinib 15 mg, filgotinib 100 mg, and placebo. Tofacitinib 5 mg showed a significantly higher ACR70 response rate than filgotinib 100 mg and upadacitinib 15 mg. Tofacitinib 5 mg, filgotinib 200 mg, and placebo showed a significantly lower serious adverse event rate than upadacitinib 15 mg.
Tofacitinib, baricitinib, upadacitinib, and filgotinib were effective treatment options for RA patients with an inadequate response to bDMARDs but with different efficacy and safety profiles.
评估托法替尼、巴瑞替尼、乌帕替尼和菲戈替尼在对生物改善病情抗风湿药物（bDMARDs）反应不足的类风湿关节炎（RA）患者中的相对疗效和耐受性。
我们进行了贝叶斯网络荟萃分析，以合并随机对照试验（RCTs）的直接和间接证据，来检查托法替尼、巴瑞替尼、乌帕替尼和菲戈替尼在对 bDMARDs 反应不足的 RA 患者中的疗效和安全性。
四项纳入了 1399 名患者的 RCT 符合纳入标准。与安慰剂相比，托法替尼、巴瑞替尼、乌帕替尼和菲戈替尼均显著实现了美国风湿病学会 20%（ACR20）应答。基于累积排序曲线下面积（SUCRA）的排序概率表明，乌帕替尼 15mg 具有成为实现 ACR20 应答率最佳治疗方案的最高概率，其次是菲戈替尼 200mg、巴瑞替尼 4mg、菲戈替尼 100mg、托法替尼 5mg 和安慰剂。基于 ACR50 应答率的 SUCRA 排序表明，巴瑞替尼 4mg 具有实现 ACR50 应答率的最高概率，其次是菲戈替尼 200mg、托法替尼 5mg、乌帕替尼 15mg、菲戈替尼 100mg 和安慰剂。托法替尼 5mg 显示出显著高于菲戈替尼 100mg 和乌帕替尼 15mg 的 ACR70 应答率。托法替尼 5mg、菲戈替尼 200mg 和安慰剂显示出显著低于乌帕替尼 15mg 的严重不良事件发生率。
托法替尼、巴瑞替尼、乌帕替尼和菲戈替尼均为对 bDMARDs 反应不足的 RA 患者的有效治疗选择，但具有不同的疗效和安全性特征。
